DDW 2015: Quantifying the Substantial Emotional Burden of Fecal Incontinence

It is widely recognized that fecal incontinence is a distressing health problem, but there is very little information in the literature on the psychological impact of this problem in the general community.

Today, I am presenting a Poster of Distinction here at Digestive Disease Week, with the findings of a community survey of a broad sample of U.S. adults that our team conducted to assess the psychological effects of having FI.

We compared the responses of 234 adults with FI (defined as accidental loss of liquid or solid stool at least once a month in the past 6 months) to those of a control sample of 328 subjects without FI, using a set of questionnaires that included multiple measures of Fecal Incontinence, a Quality of life measure (the FI-QOL Scale) and a psychological distress questionnaire(Brief Symptom Inventory – 18; or BSI-18).

We found that people with FI had significantly higher average scores (see Figure 1 below) on all dimensions of psychological distress (anxiety, depression, somatization and overall distress) on the BSI-18 questionnaire compared to those without FI symptoms), and that substantially higher proportion of FI sufferers scored in the clinically significantly distressed range on this questionnaire (BSI-GSI scores > 63) according to guidelines for BSI-18 interpretation (see Figure 2).

High psychological distress was a significant independent predictor, along with greater severity of fecal incontinence and younger age, in predicting the amount of quality-of-life impairment among the individuals with FI.

One must always be careful in assuming causality when interpreting the findings of a single-time assessment like we used here. However, these results strongly suggest that the burden of FI symptoms results in clinically significant levels of psychological distress for a substantial proportion of FI sufferers, with the majority of individuals with FI suffering from clinical levels of psychological distress, and it further seems that having FI at a relatively younger age adds to the burden of this health problem.


Figure 1.


Figure 2.



Olafur S. Palsson , Steve Heymen , William E. Whitehead . Fecal Incontinence is Associated with Clinically Significant Psychological Distress. DDW 2015 Sa1366


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